Abstract
Purpose
Sentinel node biopsy (SNB) may identify lymph node metastases in patients with papillary thyroid cancer (PTC), enabling selective application of central node dissection (CND). The aim of this study was to assess the feasibility of implementing SNB in patients undergoing thyroidectomy for a cytologically indeterminate/suspicious/malignant thyroid nodule and to determine the potential improvement in clinical outcomes and the costs associated with the SNB technique.
Methods
The treatment strategies and clinical and pathological outcomes of two retrospective cohorts of patients who underwent preoperative thyroid FNA over a 5-year period in two different centres were studied. The potential for implementing the SNB technique and the benefits and costs associated with implementation were estimated.
Results
In centre 1, in 819 adult patients who had thyroid fine-needle aspiration cytology, the final cytology was indeterminate, suspicious and diagnostic of malignancy in 113, 29 and 28 patients, respectively. One hundred eight patients were ‘suitable’ for SNB. Twenty-three of these patients had PTC, six of whom underwent CND. Of these six patients, node metastasis was absent in five—the cohort in whom prophylactic CND may have been avoided consequent to a negative ‘sentinel node’ biopsy. Morbidity attributable to CND may have been avoided in up to four patients over a 5-year period. Costs associated with implementation of SNB outweighed any potential savings.
Analysis of 491 patients in centre 2 confirmed that the benefit of SNB in PTC was similarly limited; morbidity attributable to CND may have been avoided in up to seven patients over a 5-year period.
Conclusions
Even under ideal conditions (assuming 100 % node identification rate and 0 % false negative rate), the potential short- to medium-term benefit of sentinel node biopsy in patients with thyroid cancer in centres implementing a policy of selective or routine prophylactic CND is low.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Chen SL, Iddings DM, Scheri RP, Bilchik AJ (2006) Lymphatic mapping and sentinel node analysis: current concepts and applications. CA Cancer J Clin 56(5):292–309, quiz 316–297
Chisholm EJ, Kulinskaya E, Tolley NS (2009) Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope 119(6):1135–1139. doi:10.1002/lary.20236
Sywak M, Cornford L, Roach P, Stalberg P, Sidhu S, Delbridge L (2006) Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery 140(6):1000–1005, discussion 1005–1007
Pereira JA, Jimeno J, Miquel J, Iglesias M, Munne A, Sancho JJ, Sitges-Serra A (2005) Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery 138(6):1095–1100, discussion 1100–1091
Rosenbaum MA, McHenry CR (2009) Central neck dissection for papillary thyroid cancer. Arch Otolaryngol Head Neck Surg 135(11):1092–1097. doi:10.1001/archoto.2009.158
Zetoune T, Keutgen X, Buitrago D, Aldailami H, Shao H, Mazumdar M, Fahey TJ 3rd, Zarnegar R (2010) Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. Ann Surg Oncol 17(12):3287–3293. doi:10.1245/s10434-010-1137-6
Balasubramanian SP, Harrison BJ (2011) Systematic review and meta-analysis of sentinel node biopsy in thyroid cancer. Br J Surg 98(3):334–344. doi:10.1002/bjs.7425
Huang O, Wu W, Wang O, You J, Li Q, Huang D, Hu X, Qu J, Jin C, Xiang Y, Yang K, Zhou S, Chen X, Pan Y, Guo G, Zhang X (2011) Sentinel lymph node biopsy is unsuitable for routine practice in younger female patients with unilateral low-risk papillary thyroid carcinoma. BMC Cancer 11:386. doi:10.1186/1471-2407-11-386
Ji YB, Lee KJ, Park YS, Hong SM, Paik SS, Tae K (2012) Clinical efficacy of sentinel lymph node biopsy using methylene blue dye in clinically node-negative papillary thyroid carcinoma. Ann Surg Oncol 19(6):1868–1873. doi:10.1245/s10434-011-2109-1
Perros P (2007) Guidelines for the management of thyroid cancer (trans: Group TCGU), 2nd edn. Royal College of Physicians, London
Kocjan G, Chandra A, Cross PA, Giles T, Johnson SJ, Stephenson TJ, Roughton M, Poller DN (2011) The interobserver reproducibility of thyroid fine-needle aspiration using the UK Royal College of Pathologists’ classification system. Am J Clin Pathol 135(6):852–859. doi:10.1309/AJCPZ33MVMGZKEWU
Barczynski M, Konturek A, Stopa M, Nowak W (2013) Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg 100(3):410–418. doi:10.1002/bjs.8985
Lang BH, Ng SH, Lau L, Cowling B, Wong KP, Wan KY (2013) A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid. doi:10.1089/thy.2012.0608
Moreno MA, Edeiken-Monroe BS, Siegel ER, Sherman SI, Clayman GL (2012) In papillary thyroid cancer, preoperative central neck ultrasound detects only macroscopic surgical disease, but negative findings predict excellent long-term regional control and survival. Thyroid 22(4):347–355. doi:10.1089/thy.2011.0121
National Institutes of Health (2010) Sentinel lymphnode in patients with papillary thyroid carcinoma and in patients with suspected thyroid neoplasia (SNTC). Available via Clinicaltrials.gov. http://clinicaltrials.gov/ct2/show/study/NCT01089335. Accessed 13/11/2011 2011
Authors’ contributions
Study conception and design: SPB, BJH TJS, JW and ZK; acquisition of data: SPB, JB, TJS, WLC, LS, ZK; analysis and interpretation of data: SPB, HYL, TJS, JW and ZK; drafting of the manuscript: SPB; critical revision of the manuscript: SPB, BJH, TJS, JW and ZK.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Balasubramanian, S.P., Brignall, J., Lin, H.Y. et al. Sentinel node biopsy in papillary thyroid cancer—what is the potential?. Langenbecks Arch Surg 399, 245–251 (2014). https://doi.org/10.1007/s00423-014-1168-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-014-1168-8